Berhouma M, Ni H, Delabar V, Tahhan N, Memou Salem S, Mottolese C, Vallee B
Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
Neurochirurgie. 2015 Apr-Jun;61(2-3):201-7. doi: 10.1016/j.neuchi.2013.08.010. Epub 2014 Jun 3.
The natural history of pineal cysts still remains unclear. Incidental pineal cysts have become more common which raises the question of their management. Symptomatic pineal cysts may require a surgical solution but therapeutic indications have not yet been clearly established.
From 1986 to 2012, 26 patients with pineal cysts were identified. Their medical records were retrospectively assessed focusing on the initial symptoms, imaging characteristics of the cyst, management strategy, operative technique and their complications, as well as the latest follow-up. A systematic review of the literature is also presented.
Twenty-six patients with pineal cysts were identified. The mean age was 23.5 years ranging from 7 to 49 years. Symptoms included intracranial hypertension with obstructive hydrocephalus in 18 cases and oculomotor anomalies in 12 cases. Two adult cases presented with non-specific headaches and did not require surgery. Twenty patients were operated via a suboccipital transtentorial approach with total removal of the cyst in 70% of the cases, while the remaining 4 cases were treated with an intraventricular endoscopic marsupialization associating a third ventriculostomy. Four patients required a preoperative ventriculo-peritoneal shunt due to life-threatening obstructive hydrocephalus. Overall, peri-operative mortality was nil. In the two non-operated patients, the cyst remained stable and no recurrences were observed in all operated patients with a mean follow-up of 144 months.
In the majority of incidental pineal cysts, a clinical and imaging follow-up is sufficient but occasionally not required especially in adults as very rare cases of increase in size have been reported.
松果体囊肿的自然病程仍不明确。偶然发现的松果体囊肿越来越常见，这引发了对其处理方式的疑问。有症状的松果体囊肿可能需要手术治疗，但治疗指征尚未明确确立。
1986年至2012年期间，共确定了26例松果体囊肿患者。对他们的病历进行回顾性评估，重点关注初始症状、囊肿的影像学特征、治疗策略、手术技术及其并发症，以及最新的随访情况。同时还对文献进行了系统综述。
确定了26例松果体囊肿患者。平均年龄为23.5岁，范围在7岁至49岁之间。症状包括颅内高压伴梗阻性脑积水18例，动眼神经异常12例。2例成年患者表现为非特异性头痛，无需手术。20例患者通过枕下经小脑幕入路进行手术，70%的病例囊肿完全切除，其余4例采用脑室内内镜开窗术联合第三脑室造瘘术治疗。4例患者因危及生命的梗阻性脑积水需要术前脑室 - 腹腔分流术。总体而言，围手术期死亡率为零。在2例未手术的患者中，囊肿保持稳定，所有手术患者平均随访144个月均未观察到复发。
在大多数偶然发现的松果体囊肿中，临床和影像学随访就足够了，但偶尔也不是必需的，特别是在成年人中，因为报道的囊肿增大的非常罕见。
